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. 2020 Jan 31;5(4):503-510.
doi: 10.1016/j.ekir.2020.01.007. eCollection 2020 Apr.

Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration

Paul A Rootjes  1 , Camiel L M de Roij van Zuijdewijn  1 , Muriel P C Grooteman  1 , Michiel L Bots  2 , Bernard Canaud  3   4 , Peter J Blankestijn  5 , Frans J van Ittersum  1 , Francisco Maduell  6 , Marion Morena  7 , Sanne A E Peters  8 , Andrew Davenport  9 , Robin W M Vernooij  2   5 , Menso J Nubé  1 ; HDF Pooling Project Investigators
Collaborators, Affiliations

Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration

Paul A Rootjes et al. Kidney Int Rep. .

Abstract

Introduction: Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile.

Methods: In this retrospective cohort analysis of individual participant data (IPD) from 3 randomized controlled trials (RCTs) (n = 2011), the effect of HDF and HD on 2-year peridialytic blood pressure (BP) patterns was assessed. Long-term peridialytic systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), as well as the deltas (post- minus predialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on HD and HDF, and in the latter group between quartiles of convection volume.

Results: Mean pre- and postdialysis SBP, DBP, and MAP declined significantly during follow-up (predialytic: SBP -2.16 mm Hg, DBP -2.88 mm Hg, MAP -2.64 mm Hg), PP increased (predialytic 0.96 mm Hg). Peridialytic deltas remained unaltered. Differences between the 2 modalities, or between quartiles of convection volume were not observed. BP changes were independent of various baseline characteristics, including the decline in body weight over time.

Conclusion: We speculate that the combination of a decreasing SBP and an increasing PP may be the clinical sequelae of a worsening cardiovascular system. Because especially HDF with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peridialytic BP control contributes to this effect.

Keywords: blood pressure; hemodiafiltration; hemodialysis; individual participant data; peridialytic.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Course of pre- and postdialytic blood pressure over time in hemodialysis (HD) and hemodiafiltration (HDF) patients. (a) Mean pre- and postdialytic systolic blood pressure (SBP). (b) Mean pre- and postdialytic diastolic blood pressure (DBP). (c) Mean pre- and postdialytic pulse pressure (PP). (d) Mean pre- and postdialytic mean arterial pressure (MAP). Error bars indicate 95% confidence intervals of the mean.
See this image and copyright information in PMC

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